Cognitive Outcomes and Delirium After Cardiac Neurodevelopmental Program Implementation for Children With Congenital Heart Disease.

Importance: A recent advisory from the American Heart Association delineated the potential benefits of developmental care for hospitalized children with congenital heart disease (CHD) and a critical gap in research evaluating the association of such inpatient programs with neurodevelopmental outcomes.

Objective: To investigate associations between the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program interventions, delirium, and neurodevelopment in young children (newborn through age 2 years) hospitalized with CHD.

Design, Setting, And Participants: This cohort study used quality improvement data from inpatient cardiac units at a tertiary care children's hospital in the US.

Cardiopulmonary bypass with deep hypothermic circulatory arrest results in organ-specific transcriptomic responses in pediatric swine.

The organ-level molecular response to cardiac surgery with cardiopulmonary bypass (CPB) remains inadequately understood and may be heterogeneous. Here, we measured organ-specific gene expression in a piglet model of CPB with deep hypothermic circulatory arrest (DHCA). Infant piglets underwent peripheral CPB with 75min of DHCA and 6h of critical care after separation from CPB.

Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomised, non-inferiority trial.

Background: Support for the treatment of uncomplicated appendicitis with non-operative management rather than surgery has been increasing in the literature. We aimed to investigate whether treatment of uncomplicated appendicitis with antibiotics in children is inferior to appendicectomy by comparing failure rates for the two treatments.

Methods: In this pragmatic, multicentre, parallel-group, unmasked, randomised, non-inferiority trial, children aged 5-16 years with suspected non-perforated appendicitis (based on clinical diagnosis with or without radiological diagnosis) were recruited from 11 children's hospitals in Canada, the USA, Finland, Sweden, and Singapore.

Factors Influencing Success in Endoscopic Treatment of Grade 4-5 Primary Vesicoureteric Reflux (VUR) in Infancy and Childhood.

Introduction: There is equipoise among pediatric urologists regarding endoscopic versus surgical intervention for symptomatic Grade 4-5 Vesicoureteric Reflux (VUR), particularly in infancy. Our aim was to assess outcomes of first-line endoscopic treatment in all cases of symptomatic Grade 4-5 VUR and we hypothesised that using endoscopic Dx/HA as first line management for primary VUR would obviate the need for ureteric reimplantation in the majority of cases.

Methods: Retrospective single-surgeon analysis of consecutive patients with primary Grade 4-5 VUR over 15 years.

Refractive Prediction Accuracy Using Intraoperative Aberrometry versus Barrett True-K Formula Following Corneal Refractive Surgery.

Purpose: To compare the refractive prediction accuracy of the Optiwave Refractive Analysis (ORA) SYSTEM with the Barrett True-K (BTK) formula in calculating intraocular lens (IOL) power in eyes that underwent cataract surgery after previous myopic photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK).

Methods: This retrospective study evaluated patients aged ≥22 years with prior myopic PRK or LASIK who underwent unilateral or bilateral cataract removal and monofocal IOL implantation using the ORA SYSTEM at 177 sites in the United States. Two datasets were analyzed: All Eyes (ie, all eligible eyes) and First Surgery Eyes (ie, each patient's first implanted eye).

Misinformation and Readability of Social Media Content on Pediatric Ankyloglossia and Other Oral Ties.

Importance: Diagnosis of pediatric ankyloglossia and other oral ties is increasing in part due to social media, leading to more frenotomies and excess medicalization of often normal anatomy.

Objective: To assess the accuracy and readability of social media content on pediatric ankyloglossia and other oral ties.

Design, Setting, And Participants: In this cross-sectional study, the top 200 posts on an image-based social media platform tagged with #tonguetie, #liptie, or #buccaltie were collected using a de novo account on March 27, 2023.

Breaking the Mould: Comparing 3D-Printed and Composite Bone Models in Orthopaedic Training.

Background and aim Synthetic composite bone models (reinforced solid foam) have become the standardised material used in practical orthopaedic education. However, with discussions regarding whether composite foam truly replicates human bone, there has been a drive to explore other available models. Three-dimensional (3D) printing has risen in both popularity and availability, providing a new option in the creation of anatomically accurate bone models.

Exploring the Knowledge, Attitudes, and Perceptions of Hospital Staff and Patients on Environmental Sustainability in the Operating Room: Quality Improvement Survey Study.

Background: In Canada, the health care system has been estimated to generate 33 million metric tons of greenhouse gas emissions annually. Health care systems, specifically operating rooms (ORs), are significant contributors to greenhouse gas emissions, using 3 to 6 times more energy than the hospital's average unit.

Objective: This quality improvement study aimed to investigate the knowledge, attitudes, and perceptions of staff members and patients on sustainability in the OR, as well as identify opportunities for initiatives and barriers to implementation.

Late-life protein or isoleucine restriction impacts physiological and molecular signatures of aging.

Restricting the intake of protein or the branched-chain amino acid isoleucine promotes healthspan and extends lifespan in young or adult mice. However, their effects when initiated in aged animals are unknown. Here we investigate the consequences of consuming a diet with 67% reduction of all amino acids (low AA) or of isoleucine alone (low Ile), in male and female C57BL/6J.

Perturbations of tryptophan catabolism via the kynurenine pathway are associated with stage 2 postoperative outcomes in single ventricle heart disease.

Preliminary evidence suggests perturbations of the kynurenine pathway (KP) of tryptophan metabolism in infants with single ventricle heart disease (SVHD). In 72 infants with SVHD undergoing stage 2 palliation (S2P) and 41 controls, we quantified serum KP metabolite concentrations via tandem mass spectroscopy pre-S2P and post-S2P at 2, 24, and 48 h and assessed metabolite relationships with post-S2P outcomes (length of stay, hypoxemia burden, and intubation duration). Pre-S2P, SVHD infants had lower tryptophan and serotonin levels and higher kynurenic acid, 3-hydroxykynurenine, and picolinic acid levels than controls.

Neoantigen DNA vaccines are safe, feasible, and induce neoantigen-specific immune responses in triple-negative breast cancer patients.

Background: Neoantigen vaccines can induce or enhance highly specific antitumor immune responses with minimal risk of autoimmunity. We have developed a neoantigen DNA vaccine platform capable of efficiently presenting both HLA class I and II epitopes and performed a phase 1 clinical trial in triple-negative breast cancer patients with persistent disease on surgical pathology following neoadjuvant chemotherapy, a patient population at high risk of disease recurrence.

Methods: Expressed somatic mutations were identified by tumor/normal exome sequencing and tumor RNA sequencing.

Lack of additional benefit from slow rewarming after therapeutic hypothermia for ischaemic brain injury in near-term fetal sheep.

The optimal rate of rewarming after therapeutic hypothermia is unclear. Slow rewarming may reduce cardiovascular instability and rebound seizures, but there is little controlled evidence to support this. The present study aimed to determine whether slow rewarming can improve neuroprotection after 72 h of hypothermia.

Computational Fractal-Based Neurosurgery.

Fractal geometry is a branch of mathematics used to characterize and quantify the geometrical complexity of natural objects, with many applications in different fields, including physics, astronomy, geology, meteorology, finances, social sciences, and computer graphics. In the biomedical sciences, the use of fractal parameters has allowed the introduction of novel morphometric parameters, which have been shown to be useful to characterize any biomedical images as well as any time series within different domains of applications. Specifically, in the neurosciences and neurosurgery, the use of the fractal dimension and other computationally inferred fractal parameters has offered robust morphometric quantitators to characterize the brain in its wholeness, from neurons to the cortical structure and connections, and introduced new prognostic, diagnostic, and eventually therapeutic markers of many diseases of neurosurgical interest, including brain tumors and cerebrovascular malformations, as summarized in this chapter.

An exploratory cross-cultural study of community-based health literacy interventions to promote the mental well-being of disadvantaged and disabled young Africans: a multi-method approach.

Background: This study explores the impact of community-based health literacy interventions on the health and mental well-being of disadvantaged young Africans in Zambia, Sierra Leone, Rwanda, and South Africa. The pandemic has exacerbated mental health problems amongst children and young people, underscoring the urgent need for equitable access to mental healthcare resources. Emphasizing the importance of equitable access to mental healthcare resources, the research addresses educational and income disparities in low- and middle-income countries (LMICs), particularly amongst young Africans with disabilities or vulnerabilities.

Outcome of 21 dogs treated for the portocaval subtype of extrahepatic portosystemic shunts.

Objective: To assess outcomes of dogs with side-to-side portocaval extrahepatic portosystemic shunts (PC-EHPSS) and poor portal perfusion to the liver treated with medical management alone (MM) or surgical attenuation (SA).

Study Design: Multi-institutional retrospective study.

Animals: A total of 21 dogs with PC-EHPSS (14/21 MM and 7/21 SA).

Obstacles to an Effective Transition to Adult Services for Patients with Hirschsprung Disease.

A growing number of patients with Hirschsprung disease are reaching adulthood, of whom a significant minority will require ongoing input from healthcare providers. In order to ensure patients receive the best care possible, it is essential to transition patients appropriately to adult services. This article describes the unmet need and some of the obstacles to this process and explores potential solutions, drawing on model examples for transitional care.

Nursing Roles in Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a type of mechanical circulatory support that is increasingly utilized in the United States for severe respiratory and/or cardiac failure refractory to conventional therapies. It is an expensive and complex life support modality. Moreover, patients on ECMO are critically ill and require a strong multidisciplinary care team.

Psychometric Evaluation of the Cancer Dependent Quality of Life (CancerDQoL) Questionnaire: An Individualised Measure of the Impact of Cancer and Its Treatment on Quality of Life.

Objective: The Cancer Dependent Quality of Life (CancerDQoL) questionnaire asks about the impact of cancer and its treatment on individuals' quality of life (QoL). This study evaluates the psychometric properties of the CancerDQoL in a UK sample.

Methods: Patients (n = 159) with a range of cancers, recruited from Barts Health NHS Trust and Barts Maggie's Centre, completed self-administered questionnaires: CancerDQoL, EQ-5D-VAS (health status), EORTC-QLQ-C30 (predominantly health symptoms/functioning) and W-BQ16 (well-being).